Surgical instrument



March 31, 1931. E. M. RANEY 1,798,902

SURGICAL INSTRUMENT Filed Nov. 5, 1928 50g/ij@- I.ZYJ'fi/fffflffi-Yqqef{9L-merecen PRG P12/E TOR Patented Mar. 31, 1931EDWIN ivi. nanny, or sT. Louis, Missonnr SURGICAL INSTRUMENT Applicationled November This invention relates generally to surgical instrumentsand, more particularly, to`

a certain new and useful improvement in surgical instruments of the typeknown as s tonsillotomes.

In tonsillotomy, a hemorrhage concoini` tant with the excision generallyoccurs when using an ordinary tonsillotonie having the form of a. pairof blunt edged shears, the ap io plication of a suitable astringent inthe forni preferably of a styptic'medicine being re-` quired to contractthe soft the flow of blood. i Ordinary tonsillotomes perform theeXcitissues and check between the blunt edges of the shears to masticatethe tissue along the line of cleavage and thus leave the root of thetonsil in a condition favorable to the rapid coagulation of the bloodand to the suppression of the hemorrhage. Nevertheless, the flow ofblood may not altogether be permanently sup@ pressed, especially inpatients suffering from hemorraghicdiathesis or the like, so that the*operation may be, andL often is, followed by a lesion difficult tocorrect.

I have found" that the hemorrhage may be suppressed and morbidconditions averted by a form of diatherinic tonsillotome having itsexciding members each connected to one of the opposite terminals of asource of elec` trical energy preferably furnishing an alternatingcurrent of `a frequency of not less than five hundred liilocycles persecond, coininonly referred to as aliigh frequency current.

My present invention has hence for its prime object the provision of atonsillotome 4,0 for diathermically eifecting `separation and removal ofthe. tonsil.

My present invention has for further objects the provision of atonsillotome ofthe type stated which may be readily manufactured, whichmay be conveniently manipusion of the tonsil by compressing the same L y5, 192s. seriai n lated, and which is eiicient in ance of its int theperformended functions.

And with the above and other objects in view, my invention resides inthe novel features -of form and combination of parts`hereinafterdescribed and po construction, arrangement,

inted out in the claims.

In the accompanying drawing,-`-

Figure 1 is a sectional view of the pharyni geal region of sentedtherein a human being, illustrating a tonsillotome `of my inventionorally `pre- .for a tonsillar operation;

Figure 2 isa longitudinally sectional view through the tonsillotome,`

Figure 3 is lotome; and

Figure 4 is a sectional view, of the tonsillotome, along t Referring nowmore in d ence characters to the dra trates a preferred embodiment of myinvention,` the instrument a top `plan view of the tonsilhe line 4-4,Figure 2.

etail and by refer- Wing,`which illusincludes a suitably elongated,relatively strip-like rigid member or so-called frame A of at l,at itsforward end iiected or conj end, is a prete lation handle spatulatecontour, as ,and suitably conoinedto frame A` at its rear rablyobliquelydisposed insu- 2. The frame A is approxi` mately flat andsmooth upon its upper face,

, forpurposes presently appearing, and in its spatulate or head-end 1 isprovided with a tonsillar fenestra or aperture l 3.

Integrally or otherwise xed upon `and extending continuously along` themargin of the spatulate or head-end l of frame A ure 3, is anundercut oras best seen in Fig-` recessed wall 4 providing a guide-way for thecorrespondingly spatulate head rigid co-operati fully described,` flatface and at sai for slidable `or relatively to th -endi of a likewiseelongated ng member B, presently more y and smooth on its under d facedisposed longitudinally shiftable` movement upon and e frame A. Themembers A and B are'preferably of reduced sectional area through t heirmiddle or oral portion,as

best seen in Figure 3, for both reducing the weight of the instrumentand facilitating its use, the frame A being provided longitudinally uponits opposite side margins at and adjacent its rear end with undercut orpassing downwardly through and Yout of handle 2, is one lead 9 of aconducting cable 1() for electrically connecting .the frame A with asource (not shown) of alternating electrical energy having a frequencyof at least five hundred kilocycles per second, a conveniently operableswitch or other suitable make-and-break device, as at 1 1, beingincorporated in the lead 9, as seen in Figure .1. In such manner, thestationary excidingmember 7 is connected or included' electrically in,and may be described` as the terminal of one side of, the circuit.

The other lead 12 of the conducting-cable passesfthrough a tube V13forming substantially apart of frame A and depending therefrom throughthe handle 2,- the latter being .2 preferablysplit in the plane of thertube 13 p and secured therearound by suitable fasten-r ing elements 14,as seen in Figure 2.

Disposed in a recess 15 in the upper farce of the frame A preferablyintermediate the guide-walls 6, is an insulating member 16 having acup-like chamber 17 depending into the upper end of the tube 13'.Springset by a spring 18 for normal endwise presentation through theinsulation 16 for yielding engagement with the shiftable member B, is areciprocable contact-plunger 19Y flexibly connected electrically withthe lead. 12 through a suitable aperture as at 20, lin the bottom wallof the chamber 17, as best seen in Figure 2.

The member B is likewise constructed of' suitable metallic material, anddisposed in and along the kcenter line of member B and extending fromadjacent the rear end thereof to and through its head-end v5, is a stripof insulating material 21, which is laterally extended over themargin'ofthe head-end 5 in an arcuate or horn-like shape to form an eX- cidingmember-support 22. Mounted on,

^ and insulated by the support 22 from, the

shiftable member B, is'the shiftable metallic exciding member 23, whoseexciding edge is formed complementary to, and adapted to engage thegroove of, the stationary metallic exciding member 7. A conductor'24 isembedded in the insulating strip 21 and leads from the exciding member23 to a contactbutton 25 disposed in the rear end portion of the memberB and terminating flush with the under face thereof for exposure to andcontact with the plunger 19 on predetermined movement of the shiftablemember B in operating direction, that is to say, in a direction to movethe shiftableV eXciding member 23 over the tonsillar aperture 3, both ofthe eXciding members being electrically energized in opposition when thebutton 25 engages with the contact plunger 19. In such manner also, theshiftable eXciding member 23 is adapted for inclusion in, and to provideterminal of the opposite side of, the circuit.

v A trigger 26 is pivotally supported, as at 27, upon the frame A ingripping relation with the handle 2, the latter being preferablyprovided with finger notches 28 in the usual manner. Extending from thetrigger 26 into a slot 29 in the frame A, is a dog 30 adapted toswingably pass into and out of a slot 31 in the shiftable member B forengagement with an end wall thereof to move the member B in operatingdirection on the trigger 26 being pressed or pulled towards the handle2. On the trigger 26 being actuated away from the handle 2, the dog maybe entirely disengaged from the shiftable member slot 31,

land the member B then shifted rearwardly upon the frame-A until the endportion thereof is disengaged from the guide-walls 6 and the head-end 5disengaged from the guidewall 4, whereupon, since the intermediate por,-tion of member B is narrower than the dis'- tance between vthewalls'6,'the member B may be lifted from `the frame A.

The point at which the button 25 contacts 'f the plunger 19 is selected,so that the tonsil tissue willbe firmly grasped between the excidingmembers 7 and 23 whenA the current is kapplied therebetween. Thisposition is most easily attained by the operator pressing the shiftablemember B with his thumb while grasping the handle 2, a thumb-piece 32being provided on the member B for the purpose. Thereafter the movableeXciding member 23 is gently and firmly moved by means of the trigger26V kerf-like through the tonsil tissue as it isseparated by thediathermic action of the high-frequency current 'occurringconcomitantly. The diathermic effect increases as the distance betweenthe exciding members is decreased, hence it is not necessary that thecurrent be supplied during the entire travel of the exciding member 23across the aperture 3. For this reason, the'dimensions of thecontact-button 25 are chosen to insure the passage of thecurrent'through thetonsil tissue where wanted and'cut off the 'supply ofcurrent before the completion of the ezciding movement of the memberB,as well as also to prevent a short circuit when the movable excidingmember 23 touches the stationary eX- ciding member 7 In prac-tice,asshoivn in Figure l, the tonsillotome is orally presented into thepharynx of the patient and manipulated to pass the lobe of the tonsilthrough the tonsillary aperture 3. The location of the excision havingbeen determined, the operator grasps the tonsil between the excidingmembers 7 and 23 and proceeds with the `operation as hereinbefore setforth, whereupon the operation is completed, the eect of the highfrequency current being to close the Wound, through coagulation of thetissues, after the diathermy, thereby preventing hemorrhagic lesions,the result of the operation being to effect a neat and complete andsubstantially bloodless severance of the tonsil.

Thus the excision is performed by my tonsillotome Without incising ormasticating the tissue of the tonsil, the separation being effected bydiathermy and hemorrhage prevented by the coagulation produced by thehigh frequency of the current in passing' from one exciding member ofthe tonsillotome to the other through the tissue of the tonsil along thedesired line of separation. Hence it Will be seen that my newtonsillotome, When used in combination With a source of highfrequencyalternating current, is an eiiicient instrument for the surgicalpurposes intended; it is of simple construction, light in Weight,relatively inexpensive to manufacture, and effective in operation.

While I have shown and described herein the preferred form of myinvention, it Will be understood that changes and modifications in theform, construction, arrangement, and combination of the several parts ofthe instrument may be made and substituted for those herein shown anddescribed Without departing from the nature and principle of myinvention.

Having thus described my invention, what I claim and desire to secure byLetters :Patent is:

l. In a tonsillotome, the combination with a. source of high frequencyalternating electrical current having a frequency not less than livehundred kilocycles per second, of a frame adapted for oral presentation,the tonsillar end of the frame having an aperture for the reception ofthe lobe of the tonsil, the end Wall of the aperture forming astationary exciding member, a co-operating exciding member shiftable onthe frame across said aperture, said stationary eXciding member beingconnected With one terminal of said source of current, and means forconnecting the other terminal of said source of current to `theshiftable exciding member on movement thereof to a predeterminedposition.

2. In a tonsillotome, the combination with a source of high frequencyalternating electrical current having ay frequency not less than-fivehundred kilocycles per'second, of a frame adapted for oralpresentatiomithe tonsillar endy of the frame having an aperture ingmember shiftable on the framefacross said aperture, saidstationaryexciding member being connected with one terminal of saidsource of currentyand means for con-` necting theother terminal of "saidsource of current to the shiftable exciding member on movement thereofto a predetermined position. said last mentioned means alsodisconnecting said source of current from the shiftable exciding memberprior to the termination of the exciding movement thereof.

3. In a tonsillotome, a frame adapted for oral presentation, thetonsillar end of the frame having an aperture for the reception ofthelobe of the tonsil, a metallic stationary exciding member mounted on theend Wall of the aperture, a shiftable member mounted on the frame formovement relatively to said aperture, a metallic eXciding memberinsulatably mounted on said shiftable member for passage across saidaperture, a contact-member insulatably mounted on the frame for slidablycontacting the shiftable member, a conductor mounted on said shiftablemember `for engagement with said contact-member on movement of theshiftable member to a predetermined position,`said conductor havingelectrical connection With the movablel eXciding member, means forconnecting the contact-member with one terminal of va source ofelectrical energy,`and means for connecting the other terminal of saidsource with the stationary exciding member. y

4. In a tonsillotome, a metallic frame adapted for oral presentation,`the tonsillar end of the frame having an aperture for the reception ofthe lobe of the tonsil,` the end Wall of the aperture forming astationary exciding member, ashiftable'member slidably mounted on theframe for movement relatively to said aperture, an insulating' striplongitudinallymounted `in the shiftable member and slidably contacting asurface of the frame, a spring set `contact-member normally bearingagainst said insulating strip, a conductor embedded in said insulatingstrip having one terminal exposed for selective engagement With saidcontactmember, a movable exciding member mounted on said insulatingstrip for carried movement across said aperture, the other terminal ofsaid conductor being connected to the movable exciding member, means forconnecting said contact-member With one terminal of a source ofelectrical energy, and means for connecting the other terminal of saidsource of energy With said frame.

ico

5. In a surgical instrument for diathermie tonsillotomy, meanscomprising Veo-operating excidmg members, one of which 1s slidablysliiftable .relatively to the other,A for holding the Vtonsil inoperative position, means operable conjointly'by and with said firstmentioned means for passing a Current of electricity from one to theother of said members through the interposed tonsil tissue,

Vand lmeans in connection With said last-mentioned means forautomatically regulating the duration of the passage of the current.

VIn testimony whereof, I have signed my name to this specification.

Y EDWIN M.- RANEY.

